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Month: March 2013

I’m back! And all of you who dropped off hugs on my last post are wonderful. It’s things like this that keep me convinced that everyone clamoring about how Teh Interwebs is ruining everything are entirely off base. I’ve got some posts planned and in the works, but for now, links and a brief rant! (Also, I’m still soliciting questions for a post on therapy–be sure to comment below).

Miri writes about exercise. I’m, unfortunately, not quite at the point she is in terms of attitude. But I’d like to be.

As an aside, I’d like to recommend an app/program called Fitocracy for low pressure exercising. Designed by two computer geeks (their own description!), it uses game mechanics (levels, quests, points) to track your exercise. I like it because the goal is doing a variety of activities, not losing weight. You can’t enter calories, which keeps me from getting obsessive, and you’re rewarded for doing a range of activities and building stamina, not for pounds lost.

Well-intended remarks about how I look prettier with “some meat on my bones,” or even about how “healthy” I look, get twisted through my f’d up brain-synapses into a command to start restricting again. Yeah, I hate this too. Anorexia is like a cat-piss stain on my sofa of awesome-ness. (My original analogy involved weeds in a flower garden, but aren’t you glad I went this route instead?)

If you want to comment about my progress, mention that I seem to be flourishing, or tell me I seem to be returning to a person who is in love with the world vs. caught up in a battle with myself.

Confused about the Adria Richards kerfuffle? Ask an ethicist. Dr. Free-Ride has a fabulous examination of all points.

Recognize that the response that you expect will automatically follow from politely asking someone to stop engaging in a particular behavior may not be the response other people have gotten when they have tried the approach you take as obviously one that would work.

Recognize that, especially if you’re a man, you may not know the lived history women are using to update their Bayesian priors. Maybe also recognize, following up on #2 above, that you may not know that lived history on account of having told women who might otherwise have shared it with you that they were wrong to feel the way they told you they felt about particular situations, or that they couldn’t possibly feel that way because you never felt that way in analogous situations. In other words, you may have gappy information because of how your past behavior has influenced how the women you know update their priors about you.

Religious Trauma Syndrome–Is it real?
I am…unconvinced. Not unconvinced that there are mental health problems and suffering associated with leaving particularly harmful sects, but that this is a useful or accurate label.

Firstly, despite calling it “religious”, the article seems to only be specific to Christianity. This is cool if you’re talking about Christianity only, but then please don’t call it “religious” when you mean a specific kind of religion. If there’s research to suggest that this happens across religions in the most fundamental wings of each, isn’t it more likely the result of fundamentalist belief, rather than belief itself?

Jumping off of that, isn’t it far more likely that it’s more about a set of behaviors (external loci of control, infallibility of those in power, etc) that we already know cause mental health problems? Is it useful in any way to create a separate category of response to trauma, rather than just noting the ways in which this is a permutation of PTSD (and relatedly, acute stress disorder*)?

I’m not saying that specific branches and behaviors within religion can be bad (and sometimes very bad) for mental health, but it seems incredibly political to be naming a syndrome this way–and that’s a very bad habit.

Sometime between last week and this one, I went numb–ran out of feelings. I think it was somewhere after the third friend in forty-eight hours contacted me with questions about leaving abusive relationships, between finals and Steubenville and painful anniversaries and suddenly having a living situation that went from Absolutely Planned to Horrifyingly Tenuous. Oh, and it’s my last day of therapy this week.*

And that’s the simple stuff.

Add in friends who need a Social Kate who smiles and has opinions and wit and does not resemble a posed block of wood. Sprinkle in academics, and taking a quarter off to work at a small agency that expects a lot from me. Roll it all in the stress of attending a competitive university where everyone Accomplishes Things that can be itemized on a resume–things that don’t contain scary words like atheist…and feeling anything outside Ron Weasley’s teaspoon involved too much work.

So I just started feeling numb.

It’s awful. I hate it and I go round and round between being irritated at not feeling anything, and getting angry about it…and then giving up because even anger feels muted and exhausting. It’s not terribly unusual–when you run out of emotional energy, that’s how it goes. It sucks, and I know I’m not the only one who gets this. So here’s how I minimize suckage. (The technical term, ya know.)

Lists

An idea stolen from someone–either the indomitable Captain Awkward or Keely. Each day gets two lists. List One: everything I have to accomplish that day in order to prevent the week from crashing and burning, and nothing more. Anything else you accomplish goes on List Two.

List Two starts out empty, and you have no obligation to fill it. It can be empty at the end of the day, and you will still have survived and accomplished important things and can sleep easily. If there is anything on List Two, you get to feel proud of it. You have gone above and beyond. Congratulations! Well done, you.

Excuses ahead of time are your friend.

Because the socially appropriate answer to a concerned “How are you feeling?” is almost never “My brain is being awful and I can’t feel anything and also everything fell apart last week.”, stock phrases are your friend. Among my favorites:

I haven’t been sleeping quite right, thanks for asking!
Because this is true even if it means you’ve been sleeping constantly and your brain feels like fuzz.

Oh, you know, long week. [Tired smile.]Where a “long week” is defined as any set of days where life was hard and not worth explaining.

I’m a little out of it right now. It’s probably [related thing that may or may not explain your actual problems.]Poor finals. I’m constantly blaming them–this is my most used phrase. I actually rarely find exams overwhelming, but they’re a fabulous explanation for why I’ve developed the habits of your average hermit crab.

Sorry, I have a touch of a stomachache.People with stomachaches tend to get all silent and huddle in the corner of any given gathering, trying to force their gastric juices to cooperate. I don’t particularly advocate lying, but if this gets you out of an nosy stranger’s headlights, I approve.

This terrible clip art is not the Feelings Police

Numb is okay.
There are no Feelings Police. They will not come find you and lecture you into submission for not possessing the correct emotional range. Feeling numb is weird and uncomfortable and unpleasant, but it goes away and you can survive it. Give yourself permission to feel as bad as you do, to nap as long as you need to, and to feel a little hollow.

Be greedy.

And along with that, be greedy. Will taking day off to paint your nails and consume only popcorn make you feel better? Do it. Will skipping that party to play videogames in your room feel better than pretending to feel social? You suddenly have new plans for the evening. Within the limits of your wallet and abilities, do whatever seems as though it could improve your day.

Hide in groups.The thing about large groups of people is that you can get lost in them. Everyone else will jump about and make noise and try to figure out how to split the check when Susan ate half of the onion rings that Johnny ordered, David and Sarah split an entree, and Jacob only brought large bills. And you can just sit there. Let everyone else have wild, sweeping feelings. There’s less pressure to say interesting things when everyone else is being exciting. You can tune out, drop in for the occasional murmur of agreement, and still be holding up your little corner of being social.

So there it is. Ideally, these will work this time around, and I’ll kick the fuzzy-brain feels sometime before the end of my spring break. What do you do?

* NU requires that I take the coming quarter off from classes to work Monday-Thursday, from 9-5. Therapy is only available Monday-Thursday, from 9-5. I’m sure there’s a witty name for the choice between skipping my lunch hour to get therapy and not having therapy for an eating disorder, but right now I can’t manage to find it.

There have been a few conversations going on online this week about what is and isn’t rape, who is and isn’t a rapist, and the Steubenville rape case and the HBO show Girls have been at the center of these conversations. Obviously, the two are not equivalent in terms of moral weight, but they both illustrate the complexities of sexual relationships and ways in which people we care about can be perpetrators of crimes.

We tend to agree that “no” means “no”, but what about non-verbal non-consent? What about inability to consent? What about coercion? When are these things rape? What are the terms we have for things that are not OK, but we’re not sure if they are “rape”? What does it mean if someone we like does them? What does it mean to label someone we know a “rapist”?

The episode of Girls in question depicted a man relapsing into his alcohol addiction and doing things to his girlfriend sexually that she was very uncomfortable with. It was a very graphic depiction, even for HBO, that some are calling rape.

The scene is incredibly uncomfortable, but a major contributor to the discomfort comes from the fact that the audience likes Adam and he’s doing something the audience doesn’t want him to do. Is it rape? Maybe not, but it’s definitely coercive and abusive. Is it possible to acknowledge that he did it and still like him?

And then there’s Steubenville. The level of outrage at the treatment of Jane Doe seems to be matched by the level of concern for the future of these poor boys who had such promising futures. Leaving aside for a moment how deeply troubling the discourse about promising futures is, as though Jane Doe’s future hasn’t been damaged or was less promising because she was woman who drank and had sex, there’s something worth examining about the concern being shown for these 16 year old boys being sent to prison.

They are, after all, just kids. Stupid kids who kidnapped and repeatedly violated a woman in need of medical attention, but entitled 16 year old kids who spent their entire lives being told they could do no wrong and worked very hard to succeed at their chosen passion. They are not just horrible rapists, there is more to them than that, but they are also rapists.

The thing about rapists, though, is that it is never the case that “rapist” is the only term that can be used to describe them. As easy as it is to demonize and vilify someone who commits a rape, the reality is that most rapists are friends or family of their victims. This is one of the tragedies of the crime — “rapist” often attaches itself to people who were already “friend” “star-player” “hero” “love-interest” and “protector”.

Add to this how ineffective, violent, and, yes, full of rape our prison system is, it’s really no wonder that people are sad that two boys have been condemned to that experience when they weren’t, up til now, labelled by any of the other labels that normally go with that. Instead of jumpstarting conversation about how we could fix the justice system or the moral complexities of dealing with young criminals, we instead have a fight about how Jane Doe is the real victim (she is), how these boys chose their own futures by committing the crime (they did), and how they should be punished so much more. What, exactly, does punishing them more accomplish?

I think there has to be a middle ground that says rapists are people and deserve some level of sympathy and the chance to make amends and have a future. And if we allow for that possibility, the possibility of forgiveness and a justice system that, yes, will convict rapists, but will also offer them help rather than just punishment, more victims who knew their rapists first as friends, lovers, family, and heroes could come forward with what happened knowing that three-dimensional people would be dealt with in three-dimensional ways. Perhaps we could then see rape victims as more than just victims, not just virgins and sluts, but three-dimensional people who had been victimized but were so much more than that. Dehumanizing rapists has the effect of distancing ourselves from the chilling reality that people who have raped aren’t uncommon, making them just monsters makes it that much harder for us to accept that “normal” people who are accused may well be guilty.

I am furious, absolutely furious, about how Jane Doe is not being treated as the victim, but the young men are. I am furious that there are no consequences to the other young men involved who did nothing to stop the rape and, instead, filmed and photographed the violations. I am furious that there are people who think that she deserved it because she was drunk. There are so many things to be furious about. But I am also furious that these boys are being sent to a prison system that will, in all likelihood, make them worse and possibly get them raped. And I am furious that our need for moral black and whites means that many women will never come forward because they don’t want that to happen to someone they care about, even if they are a rapist, and they don’t want to spend their lives being defined as victim when that often has so little to do with their futures.

Yesterday Andy pointed out that a list of non-going-to-therapy resources would be useful. Insurance, time, frustration with therapeutic experiences, inability to tell parents, etc, can make seeing a therapist either impossible or unappealing. Here’s a (totally incomplete) list. Please please please add other suggestions in the comments! I’ll keep updating.

Relevant disclaimer: I’m not a therapist. Most of the linked blog posts are not written by therapists. (Though most of the books are written by someone with a psych degree.)

The below are first general resources, then sorted specifically by disorder, followed by some resources if you do decide to seek therapy. If I could pick three I endorse the most, I’d say Boggle, How To Keep Moving Forward, and Don’t Tell Me To Love My Body. All three are italicized in the list.

Miscellaneous/Multi-Disorder Help & Information

DBT WorkbookThis is one of many, but it’s received very positive reception from the psych community and did get an award for being evidence based. DBT is an evidence-based therapy that focuses on mindfulness and combines many principles of Zen with therapeutic techniques.

CBT Workbook
Again, one of many, but I’ve looked through this one, and liked the formatting and set up. I’ll amend this with critiques or other suggestions if you have them. CBT is an evidence-based therapy and works for many people, but not all.

I Don’t Want To Talk About It: Overcoming the Secret Legacy of Male Depression Have a close friend or partner who is a man with depression–or are one yourself? I don’t actually have either, but I’ve heard good reviews from friends who read this. And we really don’t examine depression in men nearly as well as we should. For instance, it often manifests in feelings of numbness, or unexplained rage–not things we normally associate with depression.

What to Expect When You Call a Hotline
I really like knowing how things go before I try them. This lovely little guest post from someone on the other and of those phone lines tells you what to expect in terms of conversation (you don’t have to know what to say!) confidentiality, and experience.

Hello Cruel World: 101 Alternatives to Suicide for Teens, Freaks and Other OutlawsWritten by Kate Borenstein, this book is not teen-specific, though it’s friendly to all ages. It operates on harm reduction, which is the philosophy that less-dangerous-but-still-risky behavior is always better than more-dangerous-and-risky behavior. I really like it, and do subscribe to harm reduction (it’s supported by evidence!). You also don’t have to read Hello Cruel World from end to end–it’s very easy to just open to a page and go from there.

Science of Eating Disorders
In my pre-therapy days (also the worst times in terms of mental health, and when I did the most work to unlearn disordered habits) I often taught myself what not to do by learning all about my disorder. For instance, if most patients with anorexia ate Small Number X calories per day, I decided I was going to eat more than that every single day. To this day, I unlearn behaviors by starting from a research perspective. Also, lots of research focuses on what treatments work and which don’t do as well, which can give you some ideas for coping strategies.

This weekend was lovely (if blogging-less). Ashley was in Chicago! Along with her were Sikivu Hutchinson, Ian Cromwell, Stephanie Zvan, and Anthony Pinn for a panel on real world atheism. You might recognize some of those names. I think they…blog, or something? Who knows.

Effective addiction treatment….is mostly not present. SMART Recovery, however, is very evidence based and non-religious and I really suggest it. I’m hoping to get certified as a facilitator myself.

And now, questions for you!

How many of you (lurkers and regular commenters!) are vegan or vegetarian? (This relates to a post, I promise)

What scripts in relation to psych would you like or questions about treatment/seeking treatment do you have? I’m thinking a listicle post answering common questions, but don’t want to miss any relevant ones.

The AP Stylebook hasn’t been my favorite in the news. Recently, a memo was leaked showing some bigoted plans for same-sex spouses. (After the inevitable doubling-down, the AP did retract it.) But this has put me in a slightly better mood–the AP Stylebook now has an entry in mental illness. I strongly suggest reading the whole thing, but here are some of my favorite parts.

Avoid using mental health terms to describe non-health issues. Don’t say that an awards show, for example, was schizophrenic.

Avoid unsubstantiated statements by witnesses or first responders attributing violence to mental illness. A first responder often is quoted as saying, without direct knowledge, that a crime was committed by a person with a “history of mental illness.”

Do not assume that mental illness is a factor in a violent crime, and verify statements to that effect. A past history of mental illness is not necessarily a reliable indicator. Studies have shown that the vast majority of people with mental illness are not violent, and experts say most people who are violent do not suffer from mental illness.

Wherever possible, rely on people with mental illness to talk about their own diagnoses.

Do not describe an individual as mentally ill unless it is clearly pertinent to a story and the diagnosis is properly sourced.

I used to copy edit for our campus paper–spending a few evenings a week cross-referencing with the Stylebook. This will do real good. Plus, now we can point out journalists who disregard the rules by pointing to specific things they’ve ignored.

[I am being excessively pedantic. The average adult reads at 250 words per minute. This post is 670 words long.]

I talked a little about my feelings on personality disorders and PDs as a whole at Chicago Skepticamp (So. FUN.) and in the last post. Then I realized that few people get as into psych as I do, and as personality disorders are far too marginalized as it is, y’all might be missing some background. So here it is!

Personality disorders are on Axis II of the DSM

The DSM classifies using a five axis system. In a “full-workup” a client would be analyzed in terms of all axes. The idea is to include all factors of how behavior could be manifesting. For instance, if the patient is displaying disordered eating behavior, but hyperthyroidism hasn’t been ruled out…maybe they don’t have an ED? If they’re exhibiting erratic behavior that’s not responding to therapy or meeting criteria for something like schizophrenia, have you ruled out a brain tumor?

This doesn’t always happen in practice–which is incredibly frustrating. In a perfect world, psychiatrists and psychologists would have time to do these things, and clients would be able to afford it.

Wishful thinking aside, these are the axes.

Axis I: All the stuff you probably think of in terms of mental illness. Mood disorders, anxiety disorders, eating disorders, all of that. Also autism, a categorization location I have some quibbles about.Axis II: Personality disorders and mental retardation. Autism diagnoses used to be located here.Axis III: Stuff that is non-mental medical issues. Could be having migraines, cancer, etc.Axis IV: Pyschosocial factors. For instance, the client could be in an unstable family environment, suffering abuse, in foster care, unable to get regular sleep due to work, imprisoned etc. All of those can contribute to manifesting a more severe version of a disorder, or major mood changes.Axis V: Global Assessment of Functioning. This actually just a number from 0-100, based on the rater’s impression of how well the client can cope with day to day life tasks. Further elaboration here.

There are three categories of personality disorders. And there’s probably more PDs than you’ve heard of.

And Then These Conditional Diagnoses: (Which may or may not get added to DSM-5)
-Depressive Personality Disorder
-Negativistic/Passive-Aggressive Personality Disorder

There’s really very little research on personality disorders

This, as far as I can tell, isn’t actually because researchers don’t want to study PDs. But firstly, few people go in for treatment of their personality–because few people are distressed by their own personality. So there’s a small pool to begin with, often of people who have been jabbed into getting treatment by family or friends. (Borderline seems to be the only regularly studied one, but that just could be because DBT was developed for BPD and I read a lot about DBT.)

Secondly, research usually tries to use ‘clean’ patients, that is, people who have just one diagnosis. So, to avoid confounding data, research on OCPD is going to only want patients who have Obsessive Compulsive Personality Disorder and only Obsessive Compulsive Personality Disorder. Except…that doesn’t really happen all too often. PDs are, almost by definition, maladaptive to living in society, which results in increased stress, which can then up the risk of other disorders and suddenly….you don’t have lots of ‘clean’ patients wandering about. (Add in the complication of finding clean patients who live close enough to participate in your research and are interested and suddenly you have a very messy project on your hands. Probably better to make the psych undergraduates do Stroop tasks.)

Random stuff about mental health I’m hoping you haven’t heard before! Relevant citations and further reading are located in the links on each number.

1. You can’t be diagnosed with a personality disorder until you are 18 years of age. [use drop-down menu at link]

2. Capgras delusion: believing that a family member or friend has been replaced with an imposter. The delusion provides a fascinating inside view into ways in which our memory functions.

3. Children who will go on to develop schizophrenia are found to have specific cognitive deficits by ages 6-7. (In developmental psychopathology classes, I was told that children who developed schizophrenia were shown to have slower affect–expression of emotion, in non-psych lingo–when observers looked at home movies of said children, even at ages as young as four. However, I can’t find a citation on this, and no longer have the textbook, so add a grain of salt.)

4. Hallucinations don’t just come as things you see–there’s also auditory hallucinations, tactile hallucinations (commonly manifests as feeling things crawling on you) and olfactory hallucinations (which can be pleasant or nasty smells).

5. Because the psych profession just likes confusing you, there’s both Obsessive Compulsive Disorder and Obsessive Compulsive Personality Disorder. They’re not very similar at all.

6. People with one personality disorder often meet criteria for diagnosis with another personality disorder. This is one of many problems with the PD diagnoses–how can one have multiple personality disorders (Obvious multiple personality jokes are obvious). It may be that some of the problem is that people aren’t exactly likely to come in for treatment of a PD–how often to people describe their own personality as flawed?

7. And speaking of multiple personalities, even though Dissociative Identity Disorder (which used to be called Multiple Personality Disorder) remains in the DSM, there’s lots and lots of evidence that it’s mainly a cultural phenomenon, and not an actual disorder. [The attached link is easy to read and in depth–I recommend it]

8. In fact, Sybil, the case that spawned media interest in DID/MPD…was maybe a fraud created by an unethical psychiatrist and her poor client?

9. Marsha Linehan created Dialectal Behavioral Therapy (DBT) originally for work on those with Borderline Personality Disorder–though it’s now been shown to be effective for substance abuse, mood disorders, sexual trauma, and self-harm. It’s was groundbreaking treatment for clients who are often considered untreatable. In 2011, during a speech, Linehan told the world that she had suffered from BPD for her entire life, and developed the treatment around her own quest to survive. So basically, she’s my hero.

10. Asking someone if they are feeling suicidal will not put the idea in their head–really, don’t be afraid to ask.